Provider Demographics
NPI:1629234406
Name:CHUA CHIACO, JOHN MICHAEL SYCIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN MICHAEL
Middle Name:SYCIP
Last Name:CHUA CHIACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9170
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-9170
Mailing Address - Country:US
Mailing Address - Phone:515-574-6840
Mailing Address - Fax:515-576-7726
Practice Address - Street 1:800 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5776
Practice Address - Country:US
Practice Address - Phone:515-574-6840
Practice Address - Fax:515-576-7726
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT053623207RC0000X
IAMD-43761207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT193248Medicaid